Individual
MR. LARRY M SHUSHANSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
6 WILBUR RD, LINCOLN, RI 02865-5114
(401) 829-1209
Mailing address
6 WILBUR RD, LINCOLN, RI 02865-5114
(401) 829-1209
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW00391
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30328-8
BLUE SHIELD PROVIDER #
RI
01
—
407868
BLUE CHIP PROVIDER #
RI
Enumeration date
05/17/2006
Last updated
07/16/2025
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